Eclampsia y amaurosis total bilateral en una paciente condiagnóstico a posteriori de leucoencefalopatía posterior reversible / Eclampsia and total bilateral amaurosis in a woman subsequently diagnosed with reversible posterior leukoencephalopathy syndrome

La eclampsia es una de las complicaciones de la preeclampsiay se define ante la aparición de convulsionesgeneralizadas y/o coma en ausencia de cualquier otroproblema neurológico. En general, no suele existir déficitneurológico focal ni coma prolongado después deuna crisis. Por ello, su aparición nos debe hacer considerarotros cuadros clínicos que puedan requerir untratamiento especial.Presentamos el caso de una gestante con amaurosis bilateraltotal después de una convulsión generalizada tónicoclónica,que fue diagnosticada a posteriori de leucoencefalopatíaposterior reversible, entidad clínico-radiológicaque puede relacionarse con numerosas etiologías comoencefalopatía hipertensiva, eclampsia, insuficiencia renal otratamiento con inmunosupresores. Cursa con cefalea,alteración de la consciencia, trastornos visuales (inclusiveceguera) y convulsiones, generalmente coincidiendo conaumento rápido en las cifras de tensión arterial. La neuroimagenes esencial para su diagnóstico y el hallazgo típicoes el edema en los hemisferios cerebrales posteriores. Lahipótesis más aceptada para explicar su mecanismo fisiopatológicoes el fallo de la autorregulación cerebral condesarrollo de edema vasogénico. Su pronóstico es bueno ylas anomalías se suelen resolver completamente con el tratamientoadecuado, que no difiere del propio manejo de laeclampsia, con riguroso control de la tensión arterial (AU)

Eclampsia is a complication of preeclampsia and ischaracterized by the appearance of grand mal seizuresand/or coma, in the absence of any other neurologicalabnormalities. Neither focal neurological deficit norprolonged coma tends to develop following a crisis.Eclampsia should therefore lead us to consider otherclinical entities that may require special treatment.We report the case of a pregnant woman who presentedtotal bilateral loss of vision following a grand mal seizure.The patient was subsequently diagnosed with reversibleposterior leukoencephalopathy syndrome, which has clinicaland radiologic manifestations linked to several causes, suchas hypertensive encephalopathy, eclampsia, kidney failure,and immunosuppressant therapy. The syndrome involvesheadache, altered states of consciousness, changes in vision(including blindness), and seizures; these symptomsgenerally coincide with a rapid increase in blood pressure.Diagnosis requires neuroimaging, and the typical finding isedema in the posterior zones of the brain hemispheres.The most widely accepted hypothesis concerning thepathophysiologic mechanism underlying this syndromeis failure of cerebral autoregulation with developmentof vasogenic edema. The prognosis is good and thealterations usually resolve completely with appropriatetreatment, which is the same as for the management ofeclampsia, with strict monitoring of blood pressure (AU)

[Negative pressure pulmonary edema: 3 case reports]. / Edema pulmonar por presión negativa: a propósito de 3 casos.

Negative pressure pulmonary edema is a complication, described since 1977, caused by upper airway obstruction in both children and adults. Although its aetiopathogeny is multifactorial, especially outstanding is excessive negative intrathoracic pressure caused by the forced spontaneous inspiration of a patient against a closed glottis, that causes high arteriole and capillary fluid pressures that favor transudation into the alveolar space The resulting pulmonary edema can appear a few minutes after the obstruction of the airway or in a deferred way after several hours. The clinical manifestations are potentially serious, but normally respond well to treatment with supplemental oxygen, positive pressure mechanical ventilation and diuretics. Diagnostic suspicion is important for acting promptly. We report three clinical cases with acute negative pressure pulmonary edema.

Edema pulmonar por presión negativa: a propósito de 3 casos / Negative pressure pulmonary edema: 3 cases report

El edema agudo pulmonar por presión negativa esuna complicación descrita desde 1977 tras la obstrucciónde la vía aérea respiratoria, tanto en niños comoen adultos. Aunque su etiopatogenia es multifactorial,destaca especialmente la excesiva presión intratorácicanegativa causada por la inspiración forzada espontáneade un paciente con la glotis cerrada, que resultaen trasudación de líquido de los capilares pulmonareshacia el espacio alveolointersticial. El edema pulmonarresultante puede aparecer en pocos minutos tras laobstrucción de la vía aérea o de forma diferida al cabode varias horas. Este cuadro clínico es potencialmentegrave, pero habitualmente responde bien al tratamientocon oxigenoterapia, ventilación mecánica a presiónpositiva y diuréticos. Es importante el diagnóstico desospecha para adecuar el tratamiento con presteza.Presentamos nuestra experiencia en 3 casos clínicoscon edema agudo pulmonar por presión negativa

Negative pressure pulmonary edema is a complication, ;;described since 1977, caused by upper airway ;;obstruction in both children and adults. ;;Although its aetiopathogeny is multifactorial, especially ;;outstanding is excessive negative intrathoracic ;;pressure caused by the forced spontaneous inspiration ;;of a patient against a closed glottis, that causes ;;high arteriole and capillary fluid pressures that favor ;;transudation into the alveolar space The resulting ;;pulmonary edema can appear a few minutes after the ;;obstruction of the airway or in a deferred way after ;;several hours. The clinical manifestations are potentially ;;serious, but normally respond well to treatment ;;with supplemental oxygen, positive pressure ;;mechanical ventilation and diuretics. Diagnostic suspicion ;;is important for acting promptly. We report ;;three clinical cases with acute negative pressure pulmonary ;;edema